Meet the Partners joining Chicago

AMS Intelligent Analytics

Website: http://www.amspredict.com/

 Advanced Medical Strategies (AMS) is the premier provider of payment integrity, risk management, and business intelligence solutions to identify and address excessive claims, prevent and recoup overpayments, and effectively manage the risks associated with high-cost claimants and group health underwriting.

4L Data Intelligence

Website: https://4ldata.com/

4L Data Intelligence™ is leading the way in a new era of healthcare program and payment integrity using the patented power of Integr8 AI Risk Detection™ technology to find, fight and prevent FWA in near real-time. Integr8 AI™, coupled with our continuously credentialed provider database, creates a revolutionary provider-centric capability to dynamically detect FWA you cannot see with stacks of traditional claims data-centric editing and analytics solutions.

The 4L FWA Prevention™ solution rapidly detects and prevents FWA at five points across the claims management workflow including pre pre-payment, pre-payment and post-payment positions. At each point, patented Integr8 AI technology dynamically and continuously detects provider behaviors, relationships and outliers without the limitations of rules-based and claim data-centric solutions. In short, it enables you to see what providers are doing individually, in relationship with all other providers, and in relationship to all other claims on each-and-every claim submitted.

4L FWA Prevention pre-payment and post-payment detection and prevention results are continuously delivered in four complementary modules. These are:

• Provider Integrity Edits
• Adaptive Claims Edits
• Billing Behaviors Analysis
• Provider Schemes Analysis.

For SIU teams, the new 4L SIU Hub™ packages the expanded range of Integr8 AI powered FWA detection behaviors and schemes into easy to use views with comprehensive investigation and lead management tools. This new capability increases FWA detection, reduces complexity and increases speed-to-decision on lead triage and investigation. All so you can Find, Fight and Prevent FWA Fast™.

Alivia Analytics

Website: https://www.aliviaanalytics.com/

Your most expansive Payment Integrity and FWA partner for medical, pharmacy, vision, and dental claims. This features our powerful, configurable Alivia 360™ Platform that provides pre- and post-payment flexibility and considerable cost savings across the healthcare claims management process. It seamlessly transitions between FWA detection and Payment Integrity solutions including clinical and non-clinical audit scenarios, first- and second-pass claims editing, and COB/TPL. Alivia 360™ not only ensures comprehensive financial oversight but full adaptability to operational needs. Alivia integrates AI as an assistant, not a replacement, prioritizing ethical use, human oversight, and compliance with industry standards. Our solutions are offered as SaaS or tech-enabled services that build strong cases against inappropriate billing practices, identify new recoveries missed by legacy vendors, deliver actionable analytics, and offer automated corrections. Alivia enables healthcare payers to streamline vendor management, improving control and strategic decision-making. Schedule a discovery meeting and demo.

Ceris Health

Website: https://www.ceris.com/

CERIS has 30 years of prepay and post pay claim review and repricing experience with a 97% client retention rate. Our solutions are deep, consistent, and defensible reviews, which make CERIS the partner of choice for health plans, Medicare and Medicaid plans, and third-party administrators. CERIS’ longstanding review services and clinical expertise offer incremental value and are grounded in a sincere dedication to our valued partners. CERIS' mission is to continue to grow and deliver long term Payment Integrity services for our partners and to help them save.

Cohere Health

Website: https://coherehealth.com/

Magical

Website: https://www.getmagical.com/

Optum

Website: https://business.optum.com/en/operations-technology/payment-integrity.html

Optum is a leading information and technology-enabled health services business dedicated to helping health plans achieve payment accuracy and improve cost savings across the claim lifecycle.

Rialtic

Website: https://www.rialtic.io/

Rialtic is a next-generation platform that equips and enables players with the technology to take control of and execute their payment accuracy strategy. Rialtic’s first solution on the platform is a comprehensive code editing capability that combines the scope of editing typically found with both primary and secondary editors and merges it into a single platform supported by a modern user experience for managing policies, deviations, reporting, and provider inquiries. Our solution champions transparency — enabling greater understanding and control of your payment accuracy program and empowering payment accuracy teams to collaborate more effectively within their organization and with provider partners and employer groups.

Trend Health Partners

Website: https://www.trendhealthpartners.com/

Combining the strengths of Trend, PrecisionGX and Advent, Trend Health Partners emerges as a pioneer in healthcare financial optimization, delivering unparalleled  payment integrity and revenue cycle expertise since 2010. As a trusted partner for providers and payers, we are dedicated to elevating payment accuracy and reducing administrative costs through our innovative, tech-enabled solutions. Our robust platform and clinical team operate as a seamless extensions of a provider’s business office, resolving credit balances, overturning denials and managing claims with precision and efficiency.

At Trend Health Partners, we personalize our approach to meet the unique needs of each client, ensuring the recovery and saving of billions of dollars while supporting their long-term financial objectives. We are committed to accelerating accurate reimbursements and enhancing revenue integrity by merging clinical insights, best practices, and cutting-edge technology.

Our mission extends beyond financials; we foster collaboration and transparent communication across the healthcare spectrum, offering a suite of services that drive significant value for all stakeholders. With a legacy of industry leadership, Trend Health Partners stands at the forefront of healthcare innovation. Together, we are setting new benchmarks for collaboration, transparency and integrity in the healthcare industry.

Nokomis

Website: https://nokomishealth.com/

Nokomis was founded in 2013 by our current CEO Rich Henriksen to ensure Claim Accountability and make a difference in the healthcare system.

We are still privately owned and therefore only have to answer to our customers - that’s the way we like it.

Through 35 years in healthcare, Rich and his team compiled their deep and broad knowledge to build Nokomis and its proprietary technology, ClaimWise™. This unique technology finds patterns in claim data to identify claims for further review, regardless of dollar amount. Combined, ClaimWise™ and the Nokomis team intelligently select claims for review, finding errors even in claims that look fine at face value.